Pain Medications

Chronic pain often accompanies endometriosis. This pain can come with a woman’s period (dysmenorrhea) or with sex (dyspareunia), however, it may be present all the time and without an obvious pattern or trend. On top of providing much needed relief, managing the pain that can accompany endometriosis may also help improve a woman’s quality of life. Common pain medications used to treat endometriosis-related pain are nonsteroidal anti-inflammatory (NSAIDs). Opioids are another class of pain medication; however, their use is not recommended for the treatment of endometriosis pain.

NSAIDs

Nonsteroidal anti-inflammatory drugs are a large class of medications used to relieve pain. Examples of common pain-causing conditions that may benefit from using NSAIDs include, but are not limited to, endometriosis, osteoarthritis, psoriatic arthritis, rheumatoid arthritis, migraine, menstrual pain (dysmenorrhea), musculoskeletal sprains and strains, tendonitis, and dental-related issues. Additionally, NSAIDs are often used as a first-line treatment for generalized pain, headaches, and inflammation. NSAIDs are also used as fever-reducers. Some NSAIDs are available over-the-counter, such as aspirin, ibuprofen (Motrin, Advil), and naproxen (Aleve). Other NSAIDs, as well as higher dosages of over-the-counter NSAIDs, may be available by prescription only.

Although NSAIDs can be used to treat pain long-term, there are several risks that can accompany them. Some of these include, but are not limited to, gastrointestinal bleeding, an increased risk of developing a heart attack or stroke, skin issues such as bruising, bleeding, or rash, and allergic reactions. In order to relieve pain, NSAIDs inhibit, or block, several enzymes that are involved in the production of prostaglandins. Prostaglandins play a role in the inflammatory and pain response pathways in the body. By reducing or blocking the formation of prostaglandin, NSAIDs are able to reduce inflammation and pain.1,2

Opioids

Opioids are a class of drugs that act on the opioid receptors within the body. These receptors are primarily in the brain and spinal cord; however, they can be in other parts of the body, including the digestive and respiratory tracts. Some opioids are available via prescription, such as hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), and codeine. The illegal drug heroin is also an opioid. Opioids are designed (naturally and/or synthetically) to mimic the effects opium. Opium is a substance derived from the opium poppy plant. Like opium, opioids have pain-relieving properties. Prescription opioids are often used after surgical procedures or for serious injuries that cause acute (short-term) pain. In addition to their ability to decrease pain, opioids also impact other receptors in the body that impact our emotions, including receptors that control pleasure. Because of this, opioids can become addictive.3,4

In recent years, the number of opioid prescriptions written has increased dramatically, helping pave the way for their widespread use. This increase in availability of opioids and their inherent possibility for misuse by those trying to achieve euphoria or “get high”, has led to the current “opioid crisis” or “opioid epidemic” that dominates the news today. In order to combat the opioid crisis, as well as to prevent additional individuals from becoming addicted to these drugs, providers are encouraged to only prescribe opioid medications when absolutely necessary, and to closely monitor individuals taking them. Following this trend, prescribing opioids for the treatment of chronic (long-term) pain, like in the case of endometriosis, has become discouraged.3,4

The Benefits and Risks of Pain Relievers: Q&A on NSAIDs with Sharon Hertz, MD. U.S. Food and Drug Administration. https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm107856.htm. Published September 24, 2015. Accessed April 25, 2018.

What Are NSAIDs? The American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/treatment/what-are-nsaids/. Published January 2009. Accessed April 25, 2018.

Misuse of Prescription Drugs. National Institutes of Health: National Institute on Drug Abuse. https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/which-classes-prescription-drugs-are-commonly-misused. Published January 2018. Accessed April 25, 2018.

Misuse of Prescription Drugs. National Institutes of Health: National Institute on Drug Abuse. https://www.drugabuse.gov/drugs-abuse/opioids. Accessed April 25, 2018.